Family Practice, 2016, Vol. 33, No. 3, 233–237 doi:10.1093/fampra/cmv062 Advance Access publication 28 July 2015
Health Service Research
Identification and treatment of depression of older adults in primary care: findings from the São Paulo Ageing and Health Study Marcia Scazufcaa, Paulo Menezesb, Karen Tabbc, Rachel Kesterd, Wulf Rösslere and Hsiang Huanga,d,* Laboratory of Psychopathology and Psychiatric Therapeutics (LIM-23), Faculty of Medicine, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil, bDepartment of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, cSchool of Social Work, University of Illinois, Urbana-Champaign, Champaign, IL, USA, dDepartment of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA and e Department of Psychiatry, University of Zurich, Zurich, Switzerland. a
*Correspondence to Hsiang Huang, Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; E-mail: [email protected]
Abstract Background. Depression, diabetes and hypertension are major contributors to the global burden of disease; however, the majority of research on depression and co-morbid conditions originates in high-income countries. Objective. This study examines the depression identification rate and compares treatment rates of depression with those of diabetes and hypertension among elderly individuals served in primary care through the Family Health Program (FHP) in São Paulo, Brazil. Method. A total of 1558 São Paulo Ageing and Health Study participants (low-income adults ≥65 years old living in São Paulo) registered in the FHP were included for analysis. Chart review was performed for participants with an International Classification of Diseases, 10th edition (ICD-10) depression diagnosis (from survey interview) to verify if depression was recorded for these individuals. Depression, diabetes and hypertension treatment were assessed based on clinical assessments and medication checks. Results. Seventy-three participants (4.8%) had ICD-10 depression, 344 (23.2%) had confirmed diabetes and 1207 (79.3%) had confirmed hypertension. The proportion of those identified with depression by medical chart review (n = 63 for individuals whose chart could be found) was 4.8% (n = 3). Nine individuals (12.3%) with ICD-10 depression were treated. Rates of diabetes and hypertension treatment were 72.4% and 77.4%, respectively. Conclusion. Levels of treatment of depression in older adults receiving care in the FHP is very low compared to treatment rates of diabetes and hypertension. Collaborative care effectiveness trials for the treatment of depression in the FHP are needed to improve the quality of depression care for this population. Key words. Aged, Brazil, depression, depressive disorder, patient-centered care, primary health care.
Introduction Brazil is a Latin American country undergoing a socio-demographic transition, with one of the fastest ageing populations in the world. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].
By 2050, the population of those aged above 65 years old is projected to grow from 80 years in age. The majority of participants were female (60.3%) and had
Health Service Research
Identification and treatment of depression of older adults in primary care: findings from the São Paulo Ageing and Health Study Marcia Scazufcaa, Paulo Menezesb, Karen Tabbc, Rachel Kesterd, Wulf Rösslere and Hsiang Huanga,d,* Laboratory of Psychopathology and Psychiatric Therapeutics (LIM-23), Faculty of Medicine, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil, bDepartment of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, cSchool of Social Work, University of Illinois, Urbana-Champaign, Champaign, IL, USA, dDepartment of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA and e Department of Psychiatry, University of Zurich, Zurich, Switzerland. a
*Correspondence to Hsiang Huang, Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; E-mail: [email protected]
Abstract Background. Depression, diabetes and hypertension are major contributors to the global burden of disease; however, the majority of research on depression and co-morbid conditions originates in high-income countries. Objective. This study examines the depression identification rate and compares treatment rates of depression with those of diabetes and hypertension among elderly individuals served in primary care through the Family Health Program (FHP) in São Paulo, Brazil. Method. A total of 1558 São Paulo Ageing and Health Study participants (low-income adults ≥65 years old living in São Paulo) registered in the FHP were included for analysis. Chart review was performed for participants with an International Classification of Diseases, 10th edition (ICD-10) depression diagnosis (from survey interview) to verify if depression was recorded for these individuals. Depression, diabetes and hypertension treatment were assessed based on clinical assessments and medication checks. Results. Seventy-three participants (4.8%) had ICD-10 depression, 344 (23.2%) had confirmed diabetes and 1207 (79.3%) had confirmed hypertension. The proportion of those identified with depression by medical chart review (n = 63 for individuals whose chart could be found) was 4.8% (n = 3). Nine individuals (12.3%) with ICD-10 depression were treated. Rates of diabetes and hypertension treatment were 72.4% and 77.4%, respectively. Conclusion. Levels of treatment of depression in older adults receiving care in the FHP is very low compared to treatment rates of diabetes and hypertension. Collaborative care effectiveness trials for the treatment of depression in the FHP are needed to improve the quality of depression care for this population. Key words. Aged, Brazil, depression, depressive disorder, patient-centered care, primary health care.
Introduction Brazil is a Latin American country undergoing a socio-demographic transition, with one of the fastest ageing populations in the world. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].
By 2050, the population of those aged above 65 years old is projected to grow from 80 years in age. The majority of participants were female (60.3%) and had
